INTERVENTION TO INCREASE TUBERCULOSIS CASE DETECTION THROUGH COMMUNITY ENGAGEMENT AND CONTACT SCREENING IN SINDH PAKISTAN.

Main Article Content

Niaz Ahmed
Sooriya Dadlani

Keywords

Abstract

Background: The escalating risk of Tuberculosis (TB) transmission among household contacts necessitates a comprehensive analysis of Multidrug-Resistant (MDR) and Drug-Susceptible (DS) TB cases through early screening and intervention. This cross-sectional survey-based study, conducted in the Larkana district of Sindh, Pakistan, from January to August 2021, aimed to assess and address the prevalence of MDR and DS-TB among household contacts.


Methods: Verbal screening was the initial step, involving the collection of information such as symptoms, age, gender, and relation to the index case. Individuals identified through verbal screening underwent further testing, including molecular testing using GeneXpert and smear testing. The study population comprised 830 household contacts, with 100 associated with MDR-TB and 370 with DS-TB.


Results: Among the 830 household contacts, 92% of cases were confirmed as DS-TB, while 7% were identified as MDR-TB. Cough emerged as the predominant symptom, constituting 51% of MDR-TB and 54% of DS-TB cases. All confirmed cases were recommended for treatment, and preventive awareness sessions were conducted by health professionals. The study, while limited by the reliance on verbal screening data, represents a significant contribution to the evidence base for screening household contacts of TB in the Sindh province of Pakistan.


Conclusion: The findings underscore the urgency of early detection and intervention in household contacts to mitigate the spread of TB, particularly MDR-TB. Despite the limitations of verbal screening, the study emphasizes the importance of targeted screening programs and preventative measures. This research contributes valuable insights to the ongoing efforts to manage TB in the Sindh province, highlighting the need for comprehensive strategies to address both DS and MDR-TB cases within household settings.

Abstract 345 | PDF Downloads 76

References

1. Balabanova, Y., Fiebig, L., Ignatyeva, O., Riekstina, V., Danilovits, M., Jaama, K., ... & Drobniewski, F. (2017). Multidrug-resistant TB in Eastern region of the EU: is the shorter regimen an exception or a rule?. Thorax, 72(9), 850-852.
2. Cox, V., McKenna, L., Acquah, R., Reuter, A., Wasserman, S., Vambe, D., ... & Furin, J. (2020). Clinical perspectives on treatment of rifampicin-resistant/multidrug-resistant TB. The International Journal of Tuberculosis and Lung Disease, 24(11), 1134-1144.
3. De Schacht, C., Mutaquiha, C., Faria, F., Castro, G., Manaca, N., Manhiça, I., & Cowan, J. (2019). Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique. PloS one, 14(7), e0219470.
4. Deutsch-Feldman, M., Pratt, R. H., Price, S. F., Tsang, C. A., & Self, J. L. (2021). Tuberculosis— United States, 2020. Morbidity and Mortality Weekly Report, 70(12), 409.
5. Fox, G. J., Schaaf, H. S., Mandalakas, A., Chiappini, E., Zumla, A., & Marais, B. J. (2017). Preventing the spread of multidrug-resistant tuberculosis and protecting contacts of infectious cases. Clinical Microbiology and Infection, 23(3), 147-153.
6. Gupta, A., Swindells, S., Kim, S., Hughes, M. D., Naini, L., Wu, X., ... & Churchyard, G. (2020). Feasibility of identifying household contacts of rifampin-and multidrug-resistant tuberculosis cases at high risk of progression to tuberculosis disease. Clinical Infectious Diseases, 70(3), 425- 435.
7. Hansadah, T., & Sonalika, S. (2018). Health Awareness Programme on Knowledge Regarding Substance Abuse and its Consequences among Adolescents.
8. Javaid, A., Khan, M. A., Khan, M. A., Mehreen, S., Basit, A., Khan, R. A., ... & Ullah, U. (2016). Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in Peshawar, Pakistan. Asian Pacific journal of tropical medicine, 9(9), 909-912.
9. Kibret, K. T., Moges, Y., Memiah, P., & Biadgilign, S. (2017). Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies. Infectious diseases of poverty, 6(1), 1-8.
10. Koesoemadinata, R. C., McAllister, S. M., Soetedjo, N. N., Febni Ratnaningsih, D., Ruslami, R., Kerry, S., ... & Hill, P. C. (2017). Latent TB infection and pulmonary TB disease among patients with diabetes mellitus in Bandung, Indonesia. Transactions of The Royal Society of Tropical Medicine and Hygiene, 111(2), 81-89.
11. Laghari, M., Sulaiman, S. A. S., Khan, A. H., Talpur, B. A., Bhatti, Z., & Memon, N. (2019). Contact screening and risk factors for TB among the household contact of children with active TB: a way to find source case and new TB cases. BMC public health, 19(1), 1-10.
12. Opota, O., Mazza-Stalder, J., Greub, G., & Jaton, K. (2019). The rapid molecular test Xpert MTB/RIF ultra: towards improved tuberculosis diagnosis and rifampicin resistance detection. Clinical Microbiology and Infection, 25(11), 1370-1376.
13. Qadeer, E., Fatima, R., Haq, M. U., Yaqoob, A., Kyaw, N. T. T., Shah, S., ... & Isaakidis, P. (2017). Yield of facility-based verbal screening amongst household contacts of patients with multi-drug resistant tuberculosis in Pakistan. Journal of clinical tuberculosis and other mycobacterial diseases, 7, 22-27.
14. Schumacher, S. G., Wells, W. A., Nicol, M. P., Steingart, K. R., Theron, G., Dorman, S. E., ... & Gilpin, C. (2019). Guidance for studies evaluating the accuracy of sputum-based tests to diagnose tuberculosis. The Journal of infectious diseases, 220(Supplement_3), S99-S107.
15. Shi, W., Forsman, L. D., Hu, Y., Zheng, X., Gao, Y., Li, X., ... & Xu, B. (2020). Improved treatment outcome of multidrug-resistant tuberculosis with the use of a rapid molecular test to detect drug resistance in China. International Journal of Infectious Diseases, 96, 390-397.
16. Talwar, A., Tsang, C. A., Price, S. F., Pratt, R. H., Walker, W. L., Schmit, K. M., & Langer, A. J. (2019). Tuberculosis—United States, 2018. Morbidity and Mortality Weekly Report, 68(11), 257.
17. World Bank Publications. (2013). The World Bank annual report 2013. World Bank Publications.